Laser Treatment for Piles - Surgery, Operation and Side Effects

Laser piles surgery is performed under local anaesthesia by a specialized team of anaesthetists, laser proctology surgeon, and other medical staff. The following steps are carried out during the procedure:

1. The surgeon will administer spinal, local (e.g., lidocaine and prilocaine) or general anaesthesia before the surgery. Spinal and local anaesthetic methods will numb the anal region and keep the patient conscious throughout the surgery.

2. The patient will be asked to be in a lithotomy position for laser surgery.

3. The surgeon will first insert a tube called a proctoscope inside the anus. This tube contains a Doppler probe to locate the end of the blood vessels that supply the blood to the Haemorrhoids (terminal arteries).
4. The surgeon will rotate the proctoscope clockwise to find the terminal artery. If we imagine the anus as a clock, piles are present at three, seven, and 11 o’clock (a person may not necessarily have piles in all three positions). 
5. The lowermost portion of the anus, close to the skin, is pain-sensitive. Hence, the surgeon will not make any cuts in this region.
6. The region which is four cm inside the anal opening is pain-insensitive. Hence, the surgeon will perform surgery in this region. However, the patient might feel a stretch sensation post-surgery, making him or her uncomfortable.
7. After the surgeon identifies the artery, they will insert a laser fibre into the anus via the same tube. The surgeon will then apply laser shots to destroy these arteries.
8. The surgeon will use a 1470 nm diode laser to remove haemorrhoids.
9. The laser will help shrink the end of the blood vessels that supply the blood to the haemorrhoids. This step ultimately helps shrink the haemorrhoids as the blood supply is completely cut. However, it takes six weeks for the mass to fully shrink to about 60 - 80% of its original size.

The patient may expect the following before or on the day of the surgery.

Before Laser Piles Surgery

1. Pre-operative investigations: The proctologist will conduct blood tests and the following physical examinations before the surgery:
   1. Examine the inside of the anal region via anoproctoscopy.
   2. Carry out a digital rectal examination in which the doctor will insert their gloved, lubricated finger inside the anus to feel the haemorrhoids.
   3. The doctor will also ensure that the patient meets the anaesthetist before surgery. The patient's fitness will be assessed before the surgery.
2. Dietary changes: 
   1. The proctologist will advise the patient to eat foods rich in minerals and vitamins such as fruits and vegetables a day before surgery.
   2. The patient will be asked to avoid red meat and such foods that are difficult to digest.
   3. The patient also should not consume alcohol three to four days before surgery.
3. Medications: 
   1. Medications can interfere with the surgical process. The patient should ask his/her proctologist about the medicines that she can consume before or on the day of the surgery.
   2. If the patient has to take any prescription medicines, he/she will be asked to take them with very little water.

On the day of Laser Piles Surgery

1. The patient needs to reach the hospital before the scheduled time.

2. The patient will be asked to sign the consent form in the presence of his/her family.

3. The patient will be instructed to remove his street clothes and jewellery and wear a hospital gown or shorts.

4. A nurse will place an intravenous catheter in the patient’s hand or forearm and inject a mild sedative.

5. Vitals will be monitored.

6. Two hours before the surgery, the proctologist or the medical team might give the patient enemas. Enema is the injection of a liquid that is given into the large intestine via the anus. Enema helps to remove any stools trapped in the intestines.

7. The patient will then be shifted to the operation theatre.

A patient who has undergone laser piles surgery can expect the following after the surgery:

The recovery process in the hospital

1. The effect of anaesthesia will come off in four to six hours. However, the patient must maintain spinal anaesthesia care to prevent spinal headaches. Also, once the effect of anaesthesia comes off, the patient might feel a stretching sensation after the surgery, making him/her uncomfortable. 
2. The anal region will be numbed using a local anaesthetic to help the patient not feel any pain for six to12 hours.
3. The patient will also be unable to urinate due to swelling in the muscles around the anus or spasms of the pelvic muscles. Over one-third of patients can experience urinary retention post-surgery, with males being more prone to it. The proctologist may recommend catheterisation or medicines to manage this condition.  
4. Bleeding from the rectum for seven to 10 days post-surgery may also be experienced by the patient. This will be visible while passing stools.
5. The patient will also get discharged once the anaesthesia wears off and has urinated.
6. The patient must wear loose-fitting clothes while going home to be comfortable. Also, a family member or a friend must drive the patient back home.

Recovery process/expectation after hospital discharge

1. Pain relief: Laser surgery usually does not cause pain, but there is a chance that the patient may feel pain for a brief time. To ease the passage of stools, the patient will be advised to use laxatives (medicines that empty the bowel) or stool softeners.
   1. Use herbs like Isabgul husk and Triphala as laxatives
   2. Antibiotics: The proctologist will prescribe antibiotics to rule out any infection
2. Practice good bowel habits: The patient should practice following good bowel movements.
   1. Avoid putting too much pressure while passing stools.
   2. Do not stay for a longer time in the toilet.
   3. Avoid holding the stool for long.

3. Diet: Following dietary habits should be followed.

   1. The patient should slowly increase fibre intake (by eating fruits, vegetables, and whole grains).

   2. Drink liquids and eat bland food (plain rice, bananas, dry toast or crackers, apple sauce) for a few days following surgery. Afterwards, the patient can return to regular foods and gradually increase the fibre intake.

   3. Drink plenty of water (four to five litres) every day.

4. Wound care: The patient may also need some cotton or other absorbent dressing in the anal area to control the bloody drainage that may persist for several days.

5. Sitz bath: After the surgery, sitz baths should be taken by the patient for a few days. A sitz bath is simply submerging the bottom in water. Either in the bathtub, shower, or a portable sitz bath (which looks like a plastic hat upside down). Plain, warm water (no soaps or salts) should be used when. The recommended time is 10 to 15 minutes twice a day. 

First follow-up appointment

1. The doctor will ask the patient to visit him/her around 2 to 3 weeks after the surgery for follow-up.
2. The doctor will examine the treated area to detect the recovery status.
3. The doctor might also change the medication or advise the patient to continue with the previous medication for some more time, depending on the condition and recovery of the surgical area.
4. The doctor will advise the patient for further timely follow-ups as well.

Laser surgery for piles is quite popular nowadays because of the following benefits:

1. Lesser pain than any other surgical procedures
2. No need for a hospital stay
3. Safer treatment option
4. Lesser bleeding during the procedure
5. Quicker healing
6. Shorter recovery period
7. No cuts, open wounds, or sutures
8. Quicker return to regular activities
9. Shorter duration to complete the procedure
10. Higher success rate
11. Fewer follow-up visits
12. Lower risk of recurrence
13. No or minimal risk of post-surgical infections

Laser piles surgery is minimally invasive has a quick recovery rate and has various other advantages. However, there may be some risks of the surgery that a patient may experience while undergoing the procedure. Following are some of the risks and complications of laser piles surgery:

1. Pain
2. Bruising
3. Swelling in the treated area. 
4. Difficulty in passing bowel after the surgery.

When is consultation with the doctor needed?

The patient must consult the doctor when:

1. Pain or bleeding is severe
2. Experience unexpected drainage or pus coming from the rectum
3. Trouble in urination or bowel movement
4. Symptoms of infection, such as fever

If piles are not treated in time, they can be uncomfortable and may affect daily activities. Risks of delayed laser piles surgery may include:

1. Extreme burning pain while sitting
2. Bleeding in stool
3. Prolapsed haemorrhoids
4. Infection

The cost of laser piles surgery ranges from ₹40,000 to ₹1,50,000. The cost varies based on the following factors:

1. The severity of the Piles, categorised as grade I to IV.
2. Technology used.
3. Age of the patient.
4. Other medical conditions that the patient may have.
5. The type of hospital facility availed - individual room or shared.